Facilitators and Barriers to Implementation of Innovative Integrated Service Delivery for Tuberculosis, Community-acquired Pneumonia, and Chronic Obstructive Lung Diseases in Southern Nigeria: A Qualitative Research Protocol

Background: This protocol describes a study in which we would determine the facilitators and barriers to implementation of innovative integrated service delivery for tuberculosis (TB), community-acquired pneumonia (CAP), and chronic obstructive pulmonary disease (COPD), in southern Nigeria. Methods: This study will adopt a cross-sectional study design using qualitative data collection methods. It will involve key informant interviews (KIIs) for program managers and health service providers, including Directly Observed Treatment Short-course focal persons, radiographers and private care providers. Focus group discussions (FGDs) will be conducted for beneficiaries of the intervention and will include persons diagnosed and treated for TB, CAP or COPD. The study will be conducted in five hard-to-reach Local Government Areas (LGAs) in two states in Southern Nigeria. The LGAs selected for the study have perennial low TB case notifications, which may be attributed to poor active case finding. A total of twenty KIIs and four FGDs will be conducted. Results: In Nigeria, funding for single-disease programs is diminishing, hence unsustainable, making it necessary to adopt more cost-efficient approaches, including integrated service delivery, especially at the primary health care level. Conclusion: The findings from this study will help in understanding the factors that influence the implementation of TB/CAP/COPD services and also inform policy/practice on the most suitable approaches to scale up the integrated service delivery for TB/CAP/COPD in Nigeria.